The presentation built upon the short talk given by Tony in the LMSG session at HC'99 as reported in the May edition of LMSG News, and expands upon some of the issues identified in the LMSG meeting of January 1999, reported in the March 1999 edition. His talk was organised as follows:

The Clinical Problem

The Strategic Context - 1999

The Strategic Context - 1994

What is ACIS?

ACIS Implementation

Benefits

Lessons

The Future

The issues facing the Trust were similar to the rest of the NHS but can be illustrated by:1) The John Glen problem - we can send a 70 year old into orbit but we cannot retrieve the notes for our patients.

2) Airline fatalities run at 0.27/million departures, but hospital admissions carry a 3.7% risk of iatrogenic injury, & 13.6% of injuries are fatal.

3) Dr Madden introduced quotes from Lawrence Weed:Paper-based systems 'can not assist the human brain’s limited capacity to recall and process large amounts of data''If we managed travel like we manage healthcare then travel agents would book flights on the basis of the flight schedules they could remember'

With key resources of money, the estate, people, & information, a strategy was set out by the Trust which would achieve Evidence Based practice, Integrated care paths, multi-disciplinary clinical teams & use of the existing ACIS system.

This was in 1995 & they reviewed possible suppliers, but the existing supplier (EDS) was judged the best solution. Following user involvement in getting the business case approved an agreement with EDS was set out in a 9 year contract, with clear objectives : to achieve value for money, secure the lifetime of the legacy systems & to outsource the IT.

Clinical departments have been categorised into 3 groups, those that are well contained (cardiology, general surgery), the diffuse (general medicine, urology, gynaecology) & those that are very mixed in their interactions (A&E, Orthopaedics & trauma, renal, obstetrics). The first category have been equipped but it is taking more effort for the latter groups.

Benefits so far -

Structured clinical records - patient centred, with a place for everything & everything in its place, Patient lists are now accurate & complete, Summary clinical histories are available, Order status tracking can be carried out, Results can be displayed by order /day /graph. There is no duplicate data entry.